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October 26, 2006

Avian Flu, What to Do? (III)

Do you live paycheck to paycheck? If you had to live at home, separated from the rest of the world (excluding your immediate family) for six months with little notice, would you be capable of this? Do you have enough emergency rations of food, water, batteries and toilet paper?

Neither do I. Even after the recent quake and subsequent blackout which left my family powerless, we haven't gone on a crazy rampage to stock up on our essentials. We had a gas-powered grill, but very little food to cook on it. We didn't want to open the fridge and freezer, instead opting to wait for the power to come back on. Seemingly inconsequential things suddenly became more important as I unconsciously flicked light switches on and off, attempted to put food into a non-responsive microwave and my stomach growled and grumbled the whole day. I quickly realized how powerless I am without electrical power. I learned how soft we've become in responding to unexpected events.

Now imagine a crisis in which everyone was ordered to stay at home. Public gatherings would be banned. Air travel would cease completely. Whole communities would be "socially distanced," exposed people would be quarantined for 10 days of monitoring and sick people would be swiftly isolated... hopefully waste disposal, food, medications and other necessities could be dropped off in some way.

The difficult thing is figuring out if you're the right sort of sick or not. Hospital doors would be barred with police and perhaps even National Guard protecting its borders to prevent desperate people from barging in... hopefully real emergencies would grant them access. People would be evaluated for their exposure and if they met the criteria, they would be taken to the hospital. They would develop an extreme shortness of breath, like that seen in SARS, and many people would need to be put on ventilators just to keep breathing.

Typical drugs to fight this disease would not work. Everyone would want to stock up on the presumed magic bullet but governments might have to ban private stockpiling. It would be given ineffectually by inexperienced (and scared!) users who might inadvertently increase the diseases' resistance instead of fighting it off.

There is not enough of this "magic bullet" to even protect the healthcare workers who would be treating sick people. Vaccines would not be made against the outbreak... the soonest they could be made would be 5-6 months and those would be shots in the dark. There is not enough ventilators to treat all of the sick people and many people would have to be taken off (and left to die) in a desperate triage situation to save someone else's life.

This would be the reality of the Avian Flu Pandemic.

The H5N1 virus replicates and sheds more virus silently for 12-24 hours before the host starts to feel ill with headaches, fevers, chills, sweating (diaphoresis), and difficulty breathing. Strangely, the bird flu is a lower respiratory infection (rather than an upper respiratory one like other flu viruses) so there is often no runny nose or sore throat... but stranger still, there might be diarrhea. After 4 days of feeling ill, the host's breathing would become so labored that he/she would have to go to the hospital. There, the host would get oseltamivir (Tamiflu) and be placed on a respirator. If they are lucky, they will live. If not, death would come after 9 days of illness.

This is a very scary and serious disease. A flu outbreak could break our nation, killing potentially millions of citizens despite our best efforts to contain the flu, cripple our economy when millions of people are suddenly banned from working or even seeing each other... we wouldn't even be able to have funerals for lost loved ones.

What can we do?How can we prepare ourselves?How can I help?

I don't mean to scare or alarm anyone; just tell the facts as they are right now. I certainly don't have all the answers, but I'll try to address a few points of each of these questions as I learned about them during a Bioevents conference.

I will focus on the specific response of Medical Students during a Avian Flu Pandemic in my next post.

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About: This is a blog by a physician on medicine, philosophy, ethics, and education.

Disclaimer: information on this blog is for medical entertainment purposes only, learning is optional. Whatever you read here does not constitute as medical advice; it is merely not my second opinion. Any similarity to real patient stories are purely coincidental, all private information has been deidentified to HIPAA standards and fictionalized to protect the innocent.

My words are my own and do not reflect the thoughts/opinions of My Medical School, My Hospital, My Clinic, My Employer or any other Unfortunate Souls who have had the ill-fortune of associating with me.